Medicine drives it all – Managed Care Matters

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The “complaints-centered” approach to handling workers’ compensation claims is misleading.

Listen to me.

You are a parent of a sick child. Her pediatrician wants me to get you some ear tubes and an antibiotic. The insurance company’s claims rep denies the claim, requesting an X-ray and a Tylenol instead, telling you to call back in a few days if it doesn’t work.

Of course, the claim rep thinks he’s doing the right thing and has decades of experience, but no medical training, no RNs or any other designations. You appeal to your daughter’s case manager, who agrees with the pediatrician.

And the claims representative rejects the case manager’s recommendation.

24 hours later, your daughter has a fever and is hoarse from screaming and you are in the local emergency room, you are about to lose your mind.

This is how nearly all workers’ taxpayers “manage” medical care.

Claimers / appraisers / examiners with zero formal medical training decide what medical care your applicants receive.

They approve of opioids and spinal cord stimulators because they don’t want to hear from a lawyer.

They deny interventions because, well, because they don’t to think are needed.

They refuse to pay for behavioral health because they don’t want to “own the psyche.”

They “certify” 24 PT visits because, well, why …

The medical units claim the results. The medical units bear the costs. The doctor guides the recovery and return to work. Medical litigation leads. Medicine guides everything.

What does this mean for you?

Would you let a claims representative determine the care your child or grandchild receives?

So why do you have claims representatives who determine the assistance your claimants receive?

(yell at a good anonymous friend who made me think more about this)

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